Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit http://skinhelpdesk.com


Cosmetic Dermatology Industry: (Risk of) New entrants (Part 2)

Greater Middle East
Greater Middle East (Photo credit: Wikipedia)
The threat of new entrants in Cosmetic Dermatology depends on 2 main factors. The licensing process and the initial investment. The licensing process for dermatologists has never been an issue in India. But It was a huge barrier in most parts of Middle East. However the regulatory bottle necks are changing fast. The recent socio-political changes in the Middle East may also have a significant effect on this.  We can expect an increase in the number of practicing dermatologists in the Middle East in the short to medium term.

There has been no disruptive innovation in the cosmetic devices industry comparable to Botulinum toxin and dermal fillers. The competition is increasing in the device manufacturing arena as well though it has not impacted the revenue stream of the manufacturers, because of the disproportionate increase in the number of dermatologists. Manufacturers have tried to compensate for the lack of innovation by introducing new models with minimal clinical impact. This has lead to the flooding of the market with old models that are not much different from the new models. The distributes have started offering this models on a rental basis. This has significantly reduced the initial investment involved.

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Best anti-ageing nanoparticle: Clean air

Nanoparticle Catalyst Electrode
Nanoparticle Catalyst Electrode (Photo credit: Argonne National Laboratory)
I still remember seeing a device displaying a controlled explosion inside a chamber magically producing nanoparticles from any cream or lotion that you introduce into the chamber. It was a “back to the future” moment for me! The demonstrator (with a remarkable resemblance to Einstein) almost claimed that he has a technology for controlled atomic fission. Now I even believe cosmetic dermatology is the answer to the world’s energy crisis!

On a serious note, In this short but information rich article titled  “Aging in a polluted world”, [1] Dr Zoe Diana Draelos, the editor of journal of cosmetic dermatology proposes her views on the menace of pollution. She warns about the potential problems of the “real nanoparticle”. Many of the “ageing gracefully” proponents may not quite like her closing remarks:

 “No diet or cosmetic cream can quench the reactive oxygen species created by nanoparticle pollution. Perhaps the answer to aging gracefully is too simple. Life in a healthy rural environment with clean air may be the solution to longevity.

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Seeing things in a new light: Sensors that could change dermatology

A remote control's infrared seen as near-infra...
A remote control's infrared seen as near-infrared through a still image from the camera's CCD sensor. (Photo credit: Wikipedia)
When researcher Dr Richard Curry from the University of Surrey’s Advanced Technology Institute, published his new light sensor in Nature’s Scientific Reports, there was no mention of its potential use in dermatology. Researchers believe that having a single low cost near infrared system, in addition to conventional imaging, opens up many new possibilities. [1]

“The new technology could allow surgeons to ‘see’ inside tissue to find tumours prior to surgery as well as equip consumer products, such as cameras and mobile phones, with night imaging options.”

The most exciting thing is that the sensors are highly flexible and can be produced cheaply, using the same laser-printers found in homes and offices, and unlike other sensors, do not require specialized manufacturing conditions. I have been working on the colour information captured in clinical photos for charm. I blogged about the decision tree developed by  Seoul National University College of Medicine and Seoul National University Bundang Hospital based on colour data. With this new low-cost sensor capable of differentiating a wide range of wavelengths extending from UV to near infrared, I am sure dermatology imaging is at the threshold of exciting new discoveries.

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Damn Cheap Technology

Cardiff Castle
(Photo credit: beapen)
Couple of years back, when I started doing DermaRoller (needles on a roller, made as expensive as possible by the manufacturer by making the handle gold plated with couple of needles per square inch more than the competitor), I had the notion that this damn cheap technology is going to be more effective than the expensive laser systems. I hoped to find a dermaroller next to the shaving razor as the anti-ageing low-tech equipment. Dr. Murad Alam of Northwestern University in Chicago, who led the study that demonstrated a 41% improvement in acne scars with micro-needling echoed the same feeling: "Needling is so easy to undergo, and potentially so inexpensive, that even a modest benefit may be sufficient to make this a worthwhile treatment for some patients with limited budgets." he said in an interview.[1]

Do you know where your fillers go? (I never did!) If you don’t, read this latest article in Dovepress on the ultrastructural investigation of the lips. Whether you use Juvederm Ultra 3, Juvederm Ultra Smile, Restylane Lipp or Restylane Refresh, you should know where your filler is going, or you may be dangerously close to disaster!  (BTW one of these fillers gives terrible erythema and swelling if injected superficially)This article gives a nice overview of the surgical anatomy of the perioral region too. Carruthers lip fullness grading scale may also be useful.[2]

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Artistic Dermatologists

Red lips !! ...item 2.. NSA dreams of quantum ...
(Photo credit: marsmet523)
I am not a social media expert by any stretch of imagination. But two recent articles in Dermatology Times - (Clinical Analysis for today’s skin care specialists), got me excited. The site tacitly admits that social media has almost become clinical.

One article highlights the fact that social media is unreliable as an indicator of your worth as a dermatologist, because disgruntled clients are more likely to comment on social media than satisfied ones. Googling your own name is mooted as a simple way of keeping an eye on your online reputation, my (secret) narcissistic daily pursuit. [Link ]

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DermGrandRounds - Gamified Dermatology Diagnosis

English: The crowdsourcing process in eight steps.
The crowdsourcing process in eight steps. (Photo credit: Wikipedia)
In our discussion on the #DicoDerm initiative we discussed the challenges of the newly emerging online dermatology diagnosis. We also touched upon the growing importance of crowdsourcing in dermatological diagnosis.  As the facebook kawasaki diagnosis story demonstrates crowdsourcing is here to stay. Patient privacy is the prime concern in the use of social media platforms such as facebook for clinical diagnosis. Dr Howard Green’s DermGrandRounds initiative introduces a secure platform for crowdsourcing that takes it to an exciting new level of gamification! Dermatologists and other associated clinicians participate in a competition to collectively identify difficult dermatology clinical images in a “gamified” process of crowd intelligence. DermGrandRounds also has a dermatology specific wiki. The highest contributors to the crowd sourced diagnosis and the dermatology wiki are rewarded twice weekly. There are no regional barriers to who can participate. DermGrandRounds has a mobile app as well.

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Bell’s methodology and Bell’s law on derma-neologisms?

English: Various coquina shells. Individuals i...
English: Various coquina shells. Individuals in the mollusk species Donax variabilis show diverse coloration and patterning in their phenotypes. (Photo credit: Wikipedia)
Few of my friends posted on Dermatologists Sans Borders about the frustrations of having a unique and rare name. How it is misspelt and how people invent new pronunciations. But there is an upside to this as well. If you discover a “unique” variant of a disease, you can give it your name! Bell’s palsy, disease and sign are already taken :(

Find a unique pattern of vitiligo lesions or LP sparing one side of the wrist and give it your name. You also have the option of naming procedures as well. Hold the scalpel at 47 degrees and call it xyz technique. (Is there a Bell’s procedure? If not, I should register it for future use) Our journals play a major role in encouraging these derma-neologisms. Our dermatology teaching curriculum is also to blame. I am sure the topper in any dermatology postgraduate department will be the student who knows the maximum number of names.

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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

Address

Bell Raj Eapen
Hamilton, ON
Canada